针灸联合血府逐瘀汤对不稳定型心绞痛患者临床症状、血清过氧化氢酶水平及心率变异性影响

Effect of Acupuncture Combined with Xuefu Zhuyu Decoction on Clinical Symptoms,Serum CAT Level and Heart Rate Variability in Patients with Unstable Angina Pectoris

目的探讨针灸联合血府逐瘀汤对不稳定型心绞痛(unstable angina pectoris,UA)患者临床症状、血清过氧化氢酶(catalase,CAT)水平及心率变异性(heart rate variability,HRV)的影响。方法选取辽宁中医药大学附属营口医院2017年1月-2019年1月收治的不稳定型心绞痛患者86例作为研究对象,通过随机数字表法分为对照组与观察组,每组43例,对照组给予阿司匹林肠溶片联合硫酸氢氯吡格雷口服治疗,观察组在对照组的基础上给予血府逐瘀汤联合针灸治疗,两组治疗1个月。对比分析两组临床疗效,治疗前后的各临床症状评分,血清过氧化氢酶和血管内皮功能指标的变化,并采取24 h动态心电图评价患者治疗前后HRV值的情况。结果观察组患者治疗总有效率(88.37%)明显高于对照组(69.77%),差异具有统计学意义(χ^2=4.497,P=0.034);两组治疗后胸闷、胸痛、心悸不宁、口干不饮等各项症状积分均下降,且观察组治疗后中医症状各项积分及总积分均低于对照组(P<0.05);两组治疗后血清内皮素(endothelin,ET)值下降,一氧化氮(NO)和肱动脉血管舒张功能(flow mediate dilation,FMD)值均显著升高,且观察组的ET值低于对照组,NO和FMD值高于对照组(P<0.05);两组治疗后过氧化物酶(peroxidase,POD)值下降,抗氧化酶包含超氧化物歧化酶(superoxide dismutase,SOD)、过氧化氢酶(catalase,CAT)和谷胱甘肽过氧化物酶(glutathione peroxidase,GSH-Px)值均明显升高,且观察组的POD值低于对照组,SOD、CAT和GSH-Px值均高于对照组(P<0.05);两组治疗后24 h内每连续5 min时间段测量的平均正常NN间期的标准差均数(SDANN Index)的HRV值比较无统计学意义(P>0.05);观察组治疗后24 h记录的连续正常NN间期的标准差均数(SDNN-24h)、24 h每连续5 min时间段测量的正常NN间期标准差均数(SDNN Index)、SDANN Index、24 h连续记录的正常相邻NN间期差值的均方平方根(rMSSD)、相邻NN间期差值超过50 ms的个数占总窦性心搏数的百分率(pNN50)、频域功率-24 h、最小频域功率小时、最大频域功率小时的HRV值均高于对照组(P<0.05)。结论针灸联合血府逐瘀汤可有效改善UA患者的临床症状和血管内皮指标、抗氧化能力,促使UA患者HRV增高,明显增加心脏自主神经张力,具有较好的临床意义。

Objective To investigate the effect of acupuncture combined with Xuefu Zhuyu Decoction on clinical symptoms,serum carnitine acylcarnitine translocase(CAT)level and heart rate variability(HRV)in patients with unstable angina pectoris(UA).Methods 86 UA patients admitted to Yingkou hospital affiliated to Liaoning university of traditional Chinese medicine from January 2017 to January 2019 were selected and divided into control group and observation group by random number table method,with 43 cases in each group.The control group was given oral administration of aspirin enteric-coated tablets combined with clopidogrel bisulfate;the observation group received Xuefu Zhuyu Decoction and acupuncture treatment on the basis of the control group.The two groups were followed up one month after treatment.The clinical efficacy,clinical symptom scores,serum CAT levels,vascular endothelial function and HRV values evaluated by 24-hour dynamic electrocardiogram were compared and analyzed.Results The total effective rate of the observation group was significantly higher than that of the control group(88.37%vs 69.77%,χ^2=4.497,P=0.034).The TCM symptoms scores such as chest tightness,chest pain,restlessness,and dry mouth were decreased after treatment,and were lower in the observation group than those of the control group(P<0.05);After treatment,the endothelin(ET)values decreased,meanwhile the(nitric oxide)NO and flow mediate dilation(FMD)values increased significantly,and the observation group had lower ET values as well as higher NO and FMD values than those of the control group after treatment(P<0.05).After treatment,the peroxidase(POD)values decreased,meanwhile the superoxide dismutase(SOD),CAT and GSH-Px values increased significantly,and the observation group had lower POD values as well as higher SOD,CAT and Glutathione peroxidase(GSH-Px)values than those of the control group after treatment(P<0.05).After treatment,the HRV values of 24 h standard deviation of all normal to normal intervals(SDNN-24 hours),standard deviation of all normal to normal intervals index(SDNN Index),standard deviation of average normal to normal intervals index(SDANN Index),the square root of the mean of the sum of the squares of differences between adjacent NN intervals(rMSSD),percentage of differences exceeding 50 ms between adjacent normal number of intervals(pNN50),frequency domain power-24 hours,minimum frequency domain power hours,and maximum frequency domain power hours were higher in the observation group than in the control group(P<0.05),while no difference was found in the HRV value of SDANN Index between groups(P>0.05).Conclusion Acupuncture combined with Xuefu Zhuyu Decoction can effectively improve the clinical symptoms,vascular endothelial index and anti-oxidation ability of UA patients,and promote the increase of HRV in UA patients,and significantly increase the autonomic nervous tension of the heart,which has good clinical significance.